1
59 Ogy. bul not tumor sixc or ccl1 kinetics, wcrc indicative of clinical outcome on the overall scrics. However, in stage I patients, relapse-free survival and overall survival wcrc significantly higher for patients with low [‘HITdR LI or squamous ccl1 tumors than for patients with high I’HlTdR Ll or non-squamous ccl1 tumors. When both cell kinetics and histology wcrc taken into constdcratio”, the probability of 5.year survival was I Ix)% for patients wilh slowly prolifcraring squamous cell carcinomas compared to only 29% for patients with rapidly proliferat- tng “on-squamous cell carcinomas. The data suggest thal cell kinetics and htstologycouldrcprcscntan importantmea”stoide”tifyasubgroup of pa1icnLs with high risk of rclapsc withm stage I NSCLC. Application of squamous cell carcinoma associated antigen mono- clonal radioimmunoassay in the diagnosis of bronchogenic carci- “O” lti LawWang MM, Kwan SYL, Yew W, Ycung DWC. Sham JST, Choy DTK. Deporrmenr ofNuclear Medrcine, Queen Mary /lospiral, Pokb- lum. Lung Camxr 1991;7:151-5. Blood samples from I I2 paucnta suffering from bronchogentc caret- “orna prior to any form of therapy and 28 control pallems were studied using rhc SCC RIA BEAD (Damabot Co., Japan). The mea” value of paticnu with squamous ccl1 carcinoma (SCC) was 8.606 @ml. Tripli- cate tests on all samples wcrc analyzed by the SPSS MANOVA procedure and showed a” overall F-test significant at 0.0% (PcO.05). The scnsitwty ofthc test was X4.6’%, speclficlty R7.7% and accuracy 87.1%. This rcporl showed thatthc SCC assocmtcdantlgc” monoclonal radiolmmunoassay can ald I” the diagnosis of squamous cell carcinoma of lung. It IS non-mvasivc. rapid I” prowding the result, and rcpcatable in the ttmc course of dlswsc and trcatmcnt. Further studlcs will be rcquircd to dctcrmmc its uscfulncas in csttmatmg tumor bulk, predtct- l”g I~c crrcd 0f UCBVI)C~ 0r ~CCU~~C~CC.mass screening and refm~ng hlstologul dlagnosi\. Plasma g,rowth hormone (GH)-releasing hormone levelsin patients with lung carcinoma Schopohl J,Losa M. Frey C, WolframG. HubcrR.Pcrmancllcr W etal. Klmikum Inncn.r~ndr.Med~zmu~ he Klmik. %icms.cen.~rrassr I, 8000 Munchcn 2. Clm Endocrmol lYOl:34:363-7. ~bJCCllvC: The a,m was to ,“vc~t,gatc the strum Icvcls of growth hormone rclcasmg hormone and GH I” patlcnts with lung carcmoma. Dcs~gn: After a” o\cmlght fast il plasma aamplc was collcctcd for dctcrmmatw” ofgrwth hormone rclca.\ing hormone and GH. Patlcnts: The ~“vcst~gat~o” wa\ pcrformcd in 28 patlcnts wrh “on small ccl1 lung carunoma. in 44 patxnts wth small cell lung carcinoma, and IO paticnu wth “on malignant lung d~uxrc. A groupof 37 normal subjects scrvcd as control. Mcaurcmcntx Growth hormone rclcasing hormone and GH wrc dctcrmmcd by mdwunmunoassay. Results: Paocnts with wall cell lung carcinoma showed higher plasma growth hormone rclcasmg hormone lcvcls(3Y~ 9.4 “g/l) thancontrol subjccts(l6.3 f2.1 rig/l:: P < 0.05). patients wrh no” small ccl] lung carcinoma (23.9 f 8.8 “g/l; P<O.OS),andpat~cntswlth no”mal~g”a”tlu”gdiscasc(l2.7~5.5; P < 0.05). Basal GH lcvcl was lower !” 5 pg/l ,” alI patiC” lS CxcCpt hvC patxnts wth small ccl1 lung carcinoma and one paticnt wth “on small ccl1 lung carcinoma. Concl~~onx The htghcr plasma growth hormone rclcasing hormone lc~cls m patlcn~x wtth small cell lung carcinoma compared to normal controls and pmcn~s wlh non small cell lung carcinoma and paucn~s wih “on malIgnant lung dlscase, conflrm the l’ rcqucnt ncurocndocrmc act,v”y of this particular tumour. Surgery Surgical management of lung metastases: Usefulness of resection with the neodymium:yttrium-aluminum-garnet laser with median sternotomy Kodama K. Doi 0, Higashiyama M, Tats&M. IwanagaT.Deparlmenl of Thoracic Surgery, The Cenrer for Adult Diseases, 3 Nakamichi, I- chome. Higashinari-ku. Osaka 537. J Thorac Cardiovasc Surg 1991; 101:901-8. Between May I969 and September 1989,677 metastatic lesions were resected during 107 operations in 100 patients with pulmonary metas- tasesfrom variousprimary sitesattheCenterforAdultDiseases.Osaka, Japan. Of those patients, 65 underwent conventional lateral thoracot- omy, and 35 patients had median stemotomy. No significant difference existed in actuarial survival after the first operation to remove the metastases between the two patient groups. Furthermore, local excision of 418 lesions was perfotmed in 25 patients with the neodymium:yttium- aluminum-garnet (Nd:YAG) laser. Of those, I8 patients had undergone aone-stageoperation for bilateral lesions through a median stcrnotomy approach. Although our study was not randomized, survwal of the 25 patients treated with the Nd:YAG law tends to bc longer than survival of the 75 paticnts for whom the Nd:YAG laser was not used. We concluded that aggrcssivc cxcisio” and evaporation of multiple lung metastases wtth the Nd:YAG laser under medtan slcmolomy is a safe and promising variation in technique and that thisapproach will expand the scope of surgical indications for met&static lung tumors. For a clearer demonstration of the inllucnce of differences in surgical tech- niques on long-term survival it is “ccessary to conduct randomized prospecttvc studtcs of the surgtcal tcchniqucs. Prophylactic minitracheotomy in lung resections: A randomized controlled study ha MM, Healy DM. Maghur HA, Luke DA. Departmew of Surgery, S- 067. Stanford University Medical Center, 300 Pasteur Dr., SIanford. CA 94305. J Thorac Cardiovasc Surg 1991;101:895-900. Thirty consecutive patients undergoing lung resections were ran- domized into two groups: Group A (n = 15) received minitracheotomy postoperatively and group B (n = 15) were control patients. Postopera- tive respiratory course was monitored by serial clinical assessments, chest x-ray examination, arterial blood gases, sputa bacterial cultures. and tbe patient’s requirement and response to chest physiotherapy. The Iwo groups were similarly matched in age (mea” 58.5 years), smoking habits, pulmonary functions, and surgical procedures. Postoperative pulmonary complications of collapse/consolidation developed I” II palients (two in group A and nine in group B) (p < 0.03). Four patients (all in group B) required minitracheolomy t” addition u) antibtotics and chest physiotherapy to treat their pneumonia. Chest physiotherapy requirement was less in group A than in group B, with a mea” “umber of sessions of seven in group A and eight in group B and a mea” iota1 lime of 92 minutes in group A and I12 minutes in group B. The mea” duration of minitracheotomy was 4.13 days. Minor temporary symp- lams resulted from the minitracheotomy in eight patients (42%) and included discomfort, voice changes, subcutaneous emphysema, and snider. There was onecase of long-term morbidity (5%) ski” scamng from woundinfcctionat thesiteoftheminitracheotomy. No postopcra- live deaths resulted. We conclude that the prophylactic use of mlnltra- cheotomy is safe and effective in decreasing postoperative rcsptratory complications in patients undergoing lung resections. Lobectomy with resection anastomosis in the treatment of non- small cell lung cancer A”gclcl11 CA, Janni A, Mussi A, Macchlartni P. Cauedra dl Chrrurgia Toracico. Unwers~radi PLW 150 Roma 67, 56100 PISO. Chworgia (Turin) l9Yl;4 SuppI:Y-12 Dung the pcrlod January 1975.July 19X8,79 patients (mea” age 59 years) undcrwcnt lobcctomy wh rcsectionanastomosts (LRA) for “on- small cell lung cancer (NSCLC). Lcstons were of the squamous hysto- lypc in the majority of patients (64/7Y, 81%) originating from upper lobes (n. 68) and wthout pathological hdar and/or mediastinal lymph node involvcmcnl (II. 51 , 65%). SIX patients died wthi” 30 days of surgery (7.5%). Mean follow-up was 51.5 months. and 5 and IO-year surwval rates wcrc 44 and 16% rcspcctivcly includtng penoperative deaths; local (“. 8) or systematic (n. 29) recldivation occurred in 37 palicnts, 8 pal~enis died from natural causes whout tumors. The folIowing faclors significantly predicted survival: lymph node status (NOvs Nl-2,p= 0.0002)a”dpaticntsprcopcrative status(highandlow- risk palients, p = 0.04) in single vartablc analysis; in multi-variable analysis, the sole factor which significantly affected survival was lymph

Application of squamous cell carcinoma associated antigen monoclonal radioimmunoassay in the diagnosis of bronchogenic carcinoma

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59

Ogy. bul not tumor sixc or ccl1 kinetics, wcrc indicative of clinical outcome on the overall scrics. However, in stage I patients, relapse-free

survival and overall survival wcrc significantly higher for patients with low [‘HITdR LI or squamous ccl1 tumors than for patients with high

I’HlTdR Ll or non-squamous ccl1 tumors. When both cell kinetics and histology wcrc taken into constdcratio”, the probability of 5.year

survival was I Ix)% for patients wilh slowly prolifcraring squamous cell

carcinomas compared to only 29% for patients with rapidly proliferat-

tng “on-squamous cell carcinomas. The data suggest thal cell kinetics

and htstologycouldrcprcscntan importantmea”stoide”tifyasubgroup of pa1icnLs with high risk of rclapsc withm stage I NSCLC.

Application of squamous cell carcinoma associated antigen mono-

clonal radioimmunoassay in the diagnosis of bronchogenic carci- “O”lti

LawWang MM, Kwan SYL, Yew W, Ycung DWC. Sham JST, Choy

DTK. Deporrmenr ofNuclear Medrcine, Queen Mary /lospiral, Pokb- lum. Lung Camxr 1991;7:151-5.

Blood samples from I I2 paucnta suffering from bronchogentc caret-

“orna prior to any form of therapy and 28 control pallems were studied

using rhc SCC RIA BEAD (Damabot Co., Japan). The mea” value of

paticnu with squamous ccl1 carcinoma (SCC) was 8.606 @ml. Tripli-

cate tests on all samples wcrc analyzed by the SPSS MANOVA

procedure and showed a” overall F-test significant at 0.0% (PcO.05).

The scnsitwty ofthc test was X4.6’%, speclficlty R7.7% and accuracy

87.1%. This rcporl showed thatthc SCC assocmtcdantlgc” monoclonal

radiolmmunoassay can ald I” the diagnosis of squamous cell carcinoma

of lung. It IS non-mvasivc. rapid I” prowding the result, and rcpcatable

in the ttmc course of dlswsc and trcatmcnt. Further studlcs will be

rcquircd to dctcrmmc its uscfulncas in csttmatmg tumor bulk, predtct-

l”g I~c crrcd 0f UCBVI)C~ 0r ~CCU~~C~CC. mass screening and refm~ng hlstologul dlagnosi\.

Plasma g,rowth hormone (GH)-releasing hormone levelsin patients

with lung carcinoma Schopohl J,Losa M. Frey C, WolframG. HubcrR.Pcrmancllcr W etal. Klmikum Inncn.r~ndr. Med~zmu~ he Klmik. %icms.cen.~rrassr I, 8000 Munchcn 2. Clm Endocrmol lYOl:34:363-7.

~bJCCllvC: The a,m was to ,“vc~t,gatc the strum Icvcls of growth hormone rclcasmg hormone and GH I” patlcnts with lung carcmoma.

Dcs~gn: After a” o\cmlght fast il plasma aamplc was collcctcd for

dctcrmmatw” ofgrwth hormone rclca.\ing hormone and GH. Patlcnts:

The ~“vcst~gat~o” wa\ pcrformcd in 28 patlcnts wrh “on small ccl1 lung

carunoma. in 44 patxnts wth small cell lung carcinoma, and IO

paticnu wth “on malignant lung d~uxrc. A groupof 37 normal subjects

scrvcd as control. Mcaurcmcntx Growth hormone rclcasing hormone

and GH wrc dctcrmmcd by mdwunmunoassay. Results: Paocnts with

wall cell lung carcinoma showed higher plasma growth hormone

rclcasmg hormone lcvcls(3Y~ 9.4 “g/l) thancontrol subjccts(l6.3 f2.1

rig/l:: P < 0.05). patients wrh no” small ccl] lung carcinoma (23.9 f 8.8

“g/l; P<O.OS),andpat~cntswlth no”mal~g”a”tlu”gdiscasc(l2.7~5.5;

P < 0.05). Basal GH lcvcl was lower !” 5 pg/l ,” alI patiC”lS CxcCpt hvC

patxnts wth small ccl1 lung carcinoma and one paticnt wth “on small

ccl1 lung carcinoma. Concl~~onx The htghcr plasma growth hormone

rclcasing hormone lc~cls m patlcn~x wtth small cell lung carcinoma

compared to normal controls and pmcn~s wlh non small cell lung

carcinoma and paucn~s wih “on malIgnant lung dlscase, conflrm the

l’rcqucnt ncurocndocrmc act,v”y of this particular tumour.

Surgery Surgical management of lung metastases: Usefulness of resection

with the neodymium:yttrium-aluminum-garnet laser with median sternotomy Kodama K. Doi 0, Higashiyama M, Tats&M. IwanagaT.Deparlmenl of Thoracic Surgery, The Cenrer for Adult Diseases, 3 Nakamichi, I- chome. Higashinari-ku. Osaka 537. J Thorac Cardiovasc Surg 1991; 101:901-8.

Between May I969 and September 1989,677 metastatic lesions were

resected during 107 operations in 100 patients with pulmonary metas-

tasesfrom variousprimary sitesattheCenterforAdultDiseases.Osaka,

Japan. Of those patients, 65 underwent conventional lateral thoracot-

omy, and 35 patients had median stemotomy. No significant difference

existed in actuarial survival after the first operation to remove the

metastases between the two patient groups. Furthermore, local excision of 418 lesions was perfotmed in 25 patients with the neodymium:yttium-

aluminum-garnet (Nd:YAG) laser. Of those, I8 patients had undergone

aone-stageoperation for bilateral lesions through a median stcrnotomy

approach. Although our study was not randomized, survwal of the 25 patients treated with the Nd:YAG law tends to bc longer than survival

of the 75 paticnts for whom the Nd:YAG laser was not used. We

concluded that aggrcssivc cxcisio” and evaporation of multiple lung

metastases wtth the Nd:YAG laser under medtan slcmolomy is a safe

and promising variation in technique and that thisapproach will expand

the scope of surgical indications for met&static lung tumors. For a

clearer demonstration of the inllucnce of differences in surgical tech-

niques on long-term survival it is “ccessary to conduct randomized

prospecttvc studtcs of the surgtcal tcchniqucs.

Prophylactic minitracheotomy in lung resections: A randomized controlled study

ha MM, Healy DM. Maghur HA, Luke DA. Departmew of Surgery, S- 067. Stanford University Medical Center, 300 Pasteur Dr., SIanford. CA 94305. J Thorac Cardiovasc Surg 1991;101:895-900.

Thirty consecutive patients undergoing lung resections were ran-

domized into two groups: Group A (n = 15) received minitracheotomy

postoperatively and group B (n = 15) were control patients. Postopera-

tive respiratory course was monitored by serial clinical assessments,

chest x-ray examination, arterial blood gases, sputa bacterial cultures. and tbe patient’s requirement and response to chest physiotherapy. The

Iwo groups were similarly matched in age (mea” 58.5 years), smoking

habits, pulmonary functions, and surgical procedures. Postoperative

pulmonary complications of collapse/consolidation developed I” II palients (two in group A and nine in group B) (p < 0.03). Four patients

(all in group B) required minitracheolomy t” addition u) antibtotics and

chest physiotherapy to treat their pneumonia. Chest physiotherapy requirement was less in group A than in group B, with a mea” “umber

of sessions of seven in group A and eight in group B and a mea” iota1 lime of 92 minutes in group A and I12 minutes in group B. The mea”

duration of minitracheotomy was 4.13 days. Minor temporary symp-

lams resulted from the minitracheotomy in eight patients (42%) and

included discomfort, voice changes, subcutaneous emphysema, and

snider. There was onecase of long-term morbidity (5%) ski” scamng

from woundinfcctionat thesiteoftheminitracheotomy. No postopcra-

live deaths resulted. We conclude that the prophylactic use of mlnltra-

cheotomy is safe and effective in decreasing postoperative rcsptratory

complications in patients undergoing lung resections.

Lobectomy with resection anastomosis in the treatment of non- small cell lung cancer

A”gclcl11 CA, Janni A, Mussi A, Macchlartni P. Cauedra dl Chrrurgia Toracico. Unwers~ra di PLW 150 Roma 67, 56100 PISO. Chworgia (Turin) l9Yl;4 SuppI:Y-12

Dung the pcrlod January 1975.July 19X8,79 patients (mea” age 59

years) undcrwcnt lobcctomy wh rcsectionanastomosts (LRA) for “on-

small cell lung cancer (NSCLC). Lcstons were of the squamous hysto-

lypc in the majority of patients (64/7Y, 81%) originating from upper

lobes (n. 68) and wthout pathological hdar and/or mediastinal lymph node involvcmcnl (II. 51 , 65%). SIX patients died wthi” 30 days of

surgery (7.5%). Mean follow-up was 51.5 months. and 5 and IO-year

surwval rates wcrc 44 and 16% rcspcctivcly includtng penoperative deaths; local (“. 8) or systematic (n. 29) recldivation occurred in 37 palicnts, 8 pal~enis died from natural causes whout tumors. The

folIowing faclors significantly predicted survival: lymph node status

(NOvs Nl-2,p= 0.0002)a”dpaticntsprcopcrative status(highandlow-

risk palients, p = 0.04) in single vartablc analysis; in multi-variable analysis, the sole factor which significantly affected survival was lymph